Combined Therapy of Major Depression with Concomitant Borderline Personality Disorder: Comparison of Interpersonal and Cognitive Psychotherapy

Bellino, Silvio; Zizza, M.; Rinaldi, Camilla; Bogetto, Filippo

doi:10.1177/070674370705201106

Cited by 37 publications

(44 citation statements)

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“…The findings in this area are also mixed, perhaps because they have focused on a range of pharmacological and psychotherapeutic treatments. Some work has suggested that individuals with comorbid personality pathology fare more poorly with IPT than with cognitive therapy (CBT; Beck, Rush, Shaw, & Emery, 1979; Carter et al, 2011; Joyce et al, 2007), and other work found that depressed individuals with comorbid borderline personality disorder fare equally well in treatment with IPT or CBT in addition to pharmacotherapy (Bellino, Zizza, Rinaldi, & Bogetto, 2007). In comparisons of psychotherapy and pharmacotherapy, both earlier (Tyrer, Seivewright, Ferguson, Murphy, & Johnson, 1993) and more recent work (Fournier et al, 2008; Maddux et al, 2009) suggest that individuals with comorbid Axis I psychopathology and personality disorders fare better with antidepressants, and those without a personality disorder fare better with psychotherapy.…”

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confidence: 99%

The role of personality pathology in depression treatment outcome with psychotherapy and pharmacotherapy.

Levenson

Wallace²,

Fournier³

et al. 2012

Journal of Consulting and Clinical Psychology

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Background Depressed patients with comorbid personality pathology may fare worse in treatment for depression than those without this additional pathology, and comorbid personality pathology may be associated with superior response in one form of treatment relative to another, though recent findings have been mixed. We aimed to evaluate the effect of personality pathology on time to remission of patients randomly assigned to 1 of 2 treatment strategies for depression and to determine whether personality pathology moderated the effect of treatment assignment on outcome. Method Individuals undergoing an episode of unipolar major depression (n = 275) received interpersonal psychotherapy (Klerman, Weissman, Rounsaville, & Chevron, 1984) or selective serotonin reuptake inhibitor (SSRI) pharmacotherapy for depression. Depressive symptoms were measured with the HRSD-17. Remission was a mean HRSD-17 score of 7 or below over a period of 3 weeks. Personality disorders were measured according to SCID-II diagnoses, and personality pathology was measured dimensionally by summing the positive probes on the SCID-II. Results The presence of at least 1 personality disorder was not a significant predictor of time to remission, but a higher level of dimensionally measured personality pathology and the presence of borderline personality disorder were associated with a longer time to remission. Personality pathology did not moderate the effect of treatment assignment on time to remission. Conclusions The findings suggest that depressed individuals with comorbid personality pathology generally fare worse in treatment for depression, although in this report, the effect of personality pathology did not differ by the type of treatment received.

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confidence: 99%

The role of personality pathology in depression treatment outcome with psychotherapy and pharmacotherapy.

Levenson

Wallace²,

Fournier³

et al. 2012

Journal of Consulting and Clinical Psychology

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“…In previous studies performed by our group, 13,36 IPT has been efficaciously used to treat major depression in patients with concomitant BPD. However, data on treatment of core BPD symptoms with IPT are sparse.…”

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confidence: 99%

Adaptation of Interpersonal Psychotherapy to Borderline Personality Disorder: A Comparison of Combined Therapy and Single Pharmacotherapy

2010

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W La Revue canadienne de psychiatrie, vol 55, no 2, février 2010 74Objective: Combined treatment with interpersonal psychotherapy (IPT) and antidepressants (ADs) has been found more effective than single pharmacotherapy in patients with major depression and concomitant borderline personality disorder (BPD). The aim of our study is to investigate whether combined treatment with a modified version of IPT is still superior to ADs when treating patients with a single diagnosis of BPD.Method: Fifty-five consecutive outpatients with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, diagnosis of BPD were enrolled. They were randomly assigned to 2 treatment arms for 32 weeks: fluoxetine 20 to 40 mg per day plus clinical management; and fluoxetine 20 to 40 mg per day plus IPT adapted to BPD (IPT-BPD). Eleven patients (20%) discontinued treatment owing to noncompliance. Forty-four patients completed the treatment period. They were assessed at baseline, and at week 16 and 32 with: a semi-structured interview for demographic and clinical variables; Clinical Global Impression Scale (CGI-S); Hamilton Depression Rating Scale (HDRS); Hamilton Anxiety Rating Scale (HARS); Social and Occupational Functioning Assessment Scale (SOFAS); BPD Severity Index (BPD-SI); and a questionnaire for quality of life (Satisfaction Profile [SAT-P]). A univariate general linear model was performed with 2 factors: duration and type of treatment. P values of less than 0.05 were considered significant. Results:Remission rates did not differ significantly between subgroups. Duration, but not type of treatment, had a significant effect on CGI-S, HDRS, SOFAS, and total BPD-SI score changes. Combined therapy was more effective on the HARS; the items: interpersonal relationships, affective instability, and impulsivity of BPD-SI; and the factors: psychological functioning and social functioning of SAT-P. Conclusions:Combined therapy with adapted IPT was superior to fluoxetine alone in BPD patients, concerning a few core symptoms of the disorder, anxiety, and quality of life.Can J Psychiatry. 2010;55(2):74-81. Clinical Implications· IPT adapted to BPD can be an efficacious model of intervention that responds to the growing demand for manualized and time-limited treatment of BPD patients. · Pharmacotherapy (selective serotonin reuptake inhibitors) and combined treatment with IPT-BPD are both efficacious in treating BPD patients without Axis I comorbidity. · Combined treatment with IPT-BPD is more efficacious than single pharmacotherapy on a few core symptoms of BPD, anxiety symptoms, and subjective quality of life. Limitations· Owing to the exclusion of patients with Axis I comorbidity, clinical characteristics of our BPD patients can be different from clinical practice. · Assessment scales did not include an assessment instrument designed to investigate the specific mechanisms of action of IPT on BPD psychopathology. · This initial trial of IPT-BPD did not include intention-to-treat analyses.

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“…Klerman and colleagues explicitly argued in their 1984 manual that brief IPT was not intended to effect “personality change.” More recently, however, several investigative groups, including some of those originally trained by Klerman and Weissman, have attempted to adapt IPT for treatment of personality disorders (Markowitz, Bleiberg, Pessin, & Skodol, 2007; Bellino, Zizza, Rinaldi, & Bogetto, 2007). Despite disappointing results from an earlier trial (Angus & Gillies, 1994) that was largely focused on the depressive symptoms experienced by those with borderline personality disorder (BPD), Markowitz, Skodol, and Bleiberg (2006) adapted IPT for borderline personality disorder (BPD).…”

Section: Adaptations Of the Original Ipt Model For Specific Populationsmentioning

confidence: 99%

“…Markowitz, Skodol, and Bleiberg’s (2006, 2007) claim received some support from a subsequent study comparing IPT and CBT as treatments for individuals with depression and BPD, in which individuals (n=32) received either IPT plus pharmacotherapy or CT plus pharmacotherapy for 24 weeks (Bellino, Zizza, Rinaldi, & Bogetto, 2007). They found no difference between groups in proportions of participants who remitted from depression; however, IPT patients showed greater improvement in social functioning and in the domineering/controlling and intrusive/needy domains of the Inventory of Interpersonal Problems.…”

Section: Adaptations Of the Original Ipt Model For Specific Populationsmentioning

confidence: 99%

Is Interpersonal Psychotherapy Infinitely Adaptable? A Compendium of the Multiple Modifications of IPT

Frank

Ritchey

Levenson

2014

APT

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We employed standard literature search techniques and surveyed participants on the International Society for Interpersonal Psychotherapy listserve (isipt-list@googlegroups.com) to catalogue the multiple and highly creative ways in which Klerman’s and Weissman’s original concept of interpersonal psychotherapy (IPT) has been modified to meet the needs of a vast range of patient populations. Focusing first on adaptations of the individual treatment model for subgroups of adult patients, we next describe further adaptations of four major off-shoots of IPT: interpersonal counseling (IPC), IPT for adolescents (IPT-A), group IPT (IPT-G) and most recently, brief IPT (IPT-B). We then discuss IPT “in-laws,” those treatments that have married IPT with of other forms of psychotherapy for patients with bipolar disorder, panic symptomatology, and substance abuse. We conclude with that although there have been myriad successful adaptations of IPT, there remain some conditions for which IPT adaptations have not been found to be efficacious.

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Combined Therapy of Major Depression with Concomitant Borderline Personality Disorder: Comparison of Interpersonal and Cognitive Psychotherapy

Abstract: Both combined therapies are efficacious in treating major depression in patients with BPD. Differences between CT and IPT concern specific features of subjective QOL and interpersonal problems. These findings lack reliable comparisons and need to be replicated.

Cited by 37 publications

References 58 publications

The role of personality pathology in depression treatment outcome with psychotherapy and pharmacotherapy.

The role of personality pathology in depression treatment outcome with psychotherapy and pharmacotherapy.

Adaptation of Interpersonal Psychotherapy to Borderline Personality Disorder: A Comparison of Combined Therapy and Single Pharmacotherapy

Is Interpersonal Psychotherapy Infinitely Adaptable? A Compendium of the Multiple Modifications of IPT

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